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Thickened formulae: interesting facts on the treatment of regurgitation in infants

Author Dr. J. Hower, Paediatrician from Germany

Regurgitation in infants is most commonly caused by gastro-oesophageal reflux (GOR). Parents who are worried about their child’s food intake and subsequent regurgitation can, in most cases, be relieved of these worries upon receiving advice on appropriate feeding amounts, which are usually excessive.
If this does not lead to any improvement, thickened formulae (ARFM anti reflux formula milk) can be used for the dietary management of GOR.
The authors of the reviewed studies intended to give an overview of the characteristics of thickened formulae.

This overview shows that thickened formulae can reduce reflux-associated symptoms and regurgitation as well as promote weight gain. A 2008 meta-analysis of 14 randomised controlled studies was able to show a significant decrease in regurgitation and vomiting frequency for thickened formulae compared to a standard formulae.

GOR can be treated with industrial ARFM or with thickened standard formulae. Studies show that formulae with a higher viscosity can reduce the occurrence of reflux. Possible thickening agents are rice flour, corn starch, locust bean gum and soy polysaccharides. The clinical efficacy depends on the properties, viscosity and digestibility of the formulae as well as the origin of the thickening agent and the severity of the reflux. ARFM with hydrolysed protein have recently proven quite effective.
All ARFM reduce the frequency and severity of GOR and are recommended for infants with persisting symptoms after an adjustment of their food intake has not led to any improvement. The use of industrial ARFM is preferable to domestically produced formulae due to their clinically tested properties and their presumed better viscosity, digestibility and nutritional composition.

Salvatore, S et al. (2018) Thickened infant formula: What to know. Nutrition 49: 51-56 (Epub 2018 Feb 26).
Horvath, A et al. (2008) The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics, 122(6): e1268-e1277.
Penna, FJ et al. (2003) Comparison between pre-thickened and home-thickened formulas in gastroesophageal reflux treatment. Jornal de pediatria, 79(1): 49-54.